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NPI Code Detail

MEDICARE: MRS. MARISA PEREZ-MARTIN LMFT

MEDICARE:  MRS. MARISA  PEREZ-MARTIN  LMFT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family TherapistMFC 43997CA

General Provider Information

NPI Number : 1518096254
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MARISA PEREZ-MARTIN LMFT
Provider Business Mailing Address
First Line : 1411 N GRAND AVE STE 100
Second Line :
City : COVINA
State : CA
Zip : 91724-1005
Country : US
Telephone Number : 909-395-7100
Fax Number :
Provider Business Practice Location Address
First Line : 840 N AVENUE 66
Second Line :
City : LOS ANGELES
State : CA
Zip : 90042-1508
Country : US
Telephone Number : 909-395-7100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/05/2007
Last Update Date : 05/13/2024

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Directions to “ MRS. MARISA PEREZ-MARTIN LMFT” Practice Location

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